Laserfiche WebLink
CHAIN OF CUSTODY 1 ANALYSES REQUEST FORM <br /> SAMPLE COLLECTOR: I PROJECT NO.:_ SECTION NO.: 1 DATE: (� SAMPLER'S NITIALS: SERIAL <br /> L7D d790 Douglas Boulevard, Suite 200 �� ��- �� QD7 (0 ( (� T C T F (� <br /> 1 n Granite Bay, CaliforniD 93746.9d60 PROJECT NAME: SAMPLER(Slgnelur N2 a� J 1.9 <br /> LEVINE•FRICKE .(916) 786-0320 Fax: (916J 786.0366 "rTt-.S <br /> SAMPLE z ANALYSES <br /> REMARKS <br /> TYPE �h / / /��//`�V % /' TAT <br /> i �o• ��e / � 3t 'VOCs: "Metals: <br /> j <br /> ¢P°pz • - / / ❑ 8260 List ❑ CAM17 <br /> SAMPLE ID. DATE TIME <br /> V6 <br /> Q� Qa Q srr!/'OG ;P`1" ❑ 8240 Llel p RCRA <br /> �o ?° 9° 1�9i / J:� /✓: // 2Oy List <br /> ❑ LUFT <br /> I nw'- W l 13tO x x x ❑ 624 List <br /> Mw '-s 1130 x x x x <br /> MW '-7 U t2 '26 X' x X a mw - JOILL <br /> x X x x <br /> I _ <br /> SAM E RECEIP Cooiar Tamp: METHOD OF SHIPMENT: RELIN IS V: t REL) DISHE�D�gf��., 2 RELINQUISHED BY: 2 <br /> l t Cola / 1 d+•02-�p <br /> On ice ❑Amelent COOIer No: LAB REPORT ND.: (SIGN RE) (OA ) (SI-1 .SURE) (DA )' (SIGNATURE) ( TEJ <br /> FAX COC CONFIRMATION TO: (PRINTED NAME) (TIME) (PRINTED NAME) (TIME) (PRINTED NAME) (TIME) <br /> Presarvalive CorreclT 1{�' (_PP— c- fl'e ' l t`+ , <br /> ❑Yee ONO ❑NIA •J yl7 (COMPANY) R' <br /> (CO(COMPANY) (COMPANY) <br /> ANALYTICAL LABORATORY: PAX RES , REC VEb BY: 1 RE BY; 2 RECEIVED BY(LABORATORY): S <br /> ✓�'�1 off o�2.n <br /> 0,+-r SEND ROCOPYTO: ( IGN TUR ) ° TE) ATURE) (DATE) <br /> SI NATVRE) (pA ) <br /> SEND EDD T0: (PRINTED NAME) (TIME) (PRIME AME <br /> ey�+ '�� ) (TIME) (PRINTED NAME) (TIME) <br /> EMV.LASEDDS.COM <br /> (COMPANY) (COMPANY) (COMPANY) <br /> Shipping Copy(White) File Copy(Yellow) Field Copy(Pink) CHAIN Of CUSTODY-ANALYSES FORM.CDO 5 22003 <br />